What is doping?

What is Doping in Sports?

Doping refers to the use of prohibited substances or methods to enhance athletic performance, which violates both the ethical principles of fair competition and poses significant health risks to athletes. 1

Definition and Scope

Doping encompasses:

• The intentional non-therapeutic use of substances for their rewarding psychological and physiological effects to gain competitive advantage 2
• Use of banned substances and methods listed by the World Anti-Doping Agency (WADA) 1, 3
• A substance or method may be included on the prohibited list if it meets at least two of these criteria:
  • Enhances sports performance
  • Represents a risk to the athlete's health
  • Violates the spirit of sports 3

Commonly Used Substances and Methods

Prohibited Substances

• Anabolic-androgenic steroids (including testosterone): Increase muscle mass and strength 1, 2
• Peptide hormones:
  • Erythropoietin (EPO): Increases red blood cell production
  • Human growth hormone (hGH): Promotes tissue growth
  • Insulin and insulin-like growth factor I (IGF-I) 3
• Stimulants: Increase alertness, reduce fatigue
• Beta-2 agonists: Used as bronchodilators but may have anabolic effects
• Diuretics and masking agents: Used to hide evidence of other doping substances
• Glucocorticosteroids: Reduce inflammation and pain 1

Prohibited Methods

• Blood doping: Enhances oxygen delivery to muscles
• Tampering with samples: Altering or substituting doping control samples
• Gene doping: Manipulation of genes to enhance performance 3

Health Consequences

Abuse of performance-enhancing substances can lead to serious adverse effects:

• Cardiovascular: Cardiac arrest, myocardial infarction, hypertrophic cardiomyopathy, congestive heart failure, cerebrovascular accident, hypertension 1, 2
• Psychiatric: Major depression, mania, paranoia, psychosis, delusions, hallucinations, hostility, aggression 2
• Hepatic: Liver dysfunction and hepatotoxicity 1, 2
• Reproductive system:
  • In men: Testicular atrophy, subfertility, infertility
  • In women: Hirsutism, virilization, deepening of voice, clitoral enlargement, breast atrophy, male-pattern baldness, menstrual irregularities 2
• Developmental: In adolescents, premature closure of growth plates with termination of growth 2

Antidoping Programs

Effective antidoping programs involve several key components:

1. Detection and Testing

• Implementation of sophisticated testing protocols that evolve as new substances emerge 1, 4
• Biological passport programs to track athlete physiological parameters over time 4

2. Education and Prevention

• Athletes should receive formal education about the dangers of performance-enhancing substances 1
• Healthcare providers should recognize potential doping and counsel patients about abstinence 1
• Education should emphasize both health risks and ethical implications 4

3. Therapeutic Use Exemptions (TUEs)

• Official authorization allowing athletes to take otherwise prohibited medications for legitimate medical conditions 1
• Requirements include:
  • The athlete would experience significant health problems without the prohibited substance
  • The therapeutic use would not produce significant performance enhancement
  • No reasonable therapeutic alternative exists 1

4. Sanctions and Enforcement

• Clear consequences for violations serve as deterrents 4
• Schools, universities, and sports organizations should prohibit performance-enhancing drugs as a condition for participation 1

Role of Healthcare Providers

Healthcare professionals have important responsibilities:

• Recognize potential performance-enhancing drug use in athletes 1
• Directly question athletes about substance use during clinical encounters 1
• Counsel patients about the necessity of abstinence and medical consequences 1
• Support legitimate therapeutic exemption applications when appropriate 1
• Refer to specialists when needed (addiction counselors, sport psychologists, medical subspecialists) 1

Pitfalls and Challenges

• Many performance-enhancing substances lack rigorous scientific evaluation for efficacy and safety 1
• Doping methods continually evolve, often staying ahead of detection techniques 5
• Athletes may use multiple substances simultaneously, complicating detection and treatment 4
• Dietary supplements may contain prohibited substances not listed on labels 1
• The "false consensus effect" - athletes may justify use by believing others are also doping 6

The fight against doping requires ongoing collaboration between athletic governing bodies, healthcare providers, and athletes themselves, combining rigorous testing with comprehensive education about health risks and clear sanctions for violations 4.